RESUMEN
Objective: To compare effectiveness of pan-retinal photocoagulation alone versus panretinal photocoagulation combined with intravitreal bevacizumab on visual acuity and central macular thickness in patients presenting with proliferative diabetic retinopathy
Methods: This Randomized controlled trial was carried out at Armed Forces Institute of ophthalmology, Pakistan from Jan 2016 to Aug 2016. Seventy six eyes of 50 patients having proliferative diabetic retinopathy and diabetic macular edema were included in the study. All the patients were subjected to detailed clinical examination that included Uncorrected visual acuity [UCVA], best corrected visual acuity [BCVA], slit lamp examination of anterior and posterior segments. Optical coherence tomography [OCT] and fundus fluorescein angiography [FFA] were carried out and patients were divided in two groups [GP and GI]. Three monthly sessions of Pan retinal photocoagulation [PRP] using Pattern Scan Laser [PASCAL] alone was performed in group GP while PRP along with three monthly intravitreal bevacizumab [IVB] was performed in group GI. BCVA and CMT was recorded 04 weeks after the third PRP session in both the groups
Results: Seventy six eyes of 50 patients [38 in each group] were treated with three sessions of PRP alone and PRP with IVB in Group GP and GI respectively. Mean age of the patient in group GP was 57.47 +/- 6.08 years while that in group GI was 55.69 +/- 6.58. The magnitude of induced change in BCVA was 0.09 +/- 0.15 in GP while 0.22 + 0.04 in GI groups while mean induced change in CMT after treatment was 77.44 +/- 92.30 um and 117.50 +/- 93.82 um in group GP and GI
Conclusion: Laser PRP combined with IVB has superior visual and anatomical outcome than PRP alone in patients with combined presentation of PDR and DME
RESUMEN
Objective: To assess the mean change in interpalpebral fissure height and marginal reflex distance after brow suspension with autogenous fascia lata sling in patients of ptosis
Methods: This was a Quasi experimental study conducted at Department of Ophthalmology, Mayo Hospital, King Edwards Medical University Lahore, from Jan 2013 to June 2016. Included were the patients who had unilateral or bilateral ptosis with poor levator function [< 5 mm]. Informed consent was obtained from all patients after explaining about the research project. Patients were admitted in ward and all of them underwent surgery by a single surgical team. The surgical procedure was performed in supine position under general anesthesia in children and uncooperative patients. Patients were followed at week 4, 8, 12 and 24 to observe vertical interpalpebral fissure height and marginal reflex distance
Results: The mean age of the patients was 9.03 +/- 5.26 years. The mean Inter palpebral fissure height [IPFH] was 4.40+/-0.91 mm and mean MRD was 0.50 +/- 1.00 mm before surgery while after surgery it was 7.41+/-0.76 mm and 3.10 +/- 1.50 mm respectively at 04 weeks. The mean IPFH and MRD at 24 weeks postoperatively were 8.43+/-0.98 mm and 3.60 + 1.50 mm respectively. The mean change in IPFH and MRD at 24th week, were 3.90 +/- 0.34 mm and 3.50 +/- 1.00 mm
Conclusion: Brow suspension with fascia lata sling is safe and effective technique for correction of ptosis with poor levator function
RESUMEN
Objectives: To evaluate the effect of half adult dose of oral Rifampicin on mean change in best corrected visual acuity and central macular thickness in patients with central serous chorioretinopathy
Methods:Thirty-eight eyes of 31 patients with idiopathic central serous chorioretinopathy [CSCR] were registered. Unaided Visual acuity, best corrected visual acuity was documented and detailed slit lamp examination along with dilated ophthalmoscopy was performed. All subjects were treated with oral Rifampicin 300 mg [half adult dose] daily for 03 months. Patients underwent a complete ocular and systemic examination as well as central macular thickness [CMT] measurement by optical coherence tomography [OCT] every month after starting treatment until four months. Fundus fluorescein angiography [FFA] was performed in recurrent cases. Liver function tests were carried out prior to the treatment and during follow up period
Results:A total of 38 eyes of 31 patients [24 males, 07 females] were included in the study. Mean age of patients was 36.16+/-3.19 years [range 30-44]. Mean best corrected visual acuity [BCVA] before treatment was 0.56+/-0.11 and improved to 0.47+/-0.14 at 04 weeks [P<0.001] of treatment. The mean CMT at the time of presentation was 494.39+/-96.29 um and was decreased to 306.90+/-50.71 um after 04 weeks of treatment [P<0.001]. The mean induced reduction in CMT was 187.48+/-122 um [P<0.001] while that in BCVA 0.41+/-0.16 at 04 weeks of treatment [P<0.001]. Liver function tests were within normal range before and after the treatment
Conclusion:Half adult dose rifampicin [300mg] is effective and safe in treatment of central serous chorioretinopathy without causing any systemic imbalance
RESUMEN
Oguchi disease is a rare form of congenital stationary night blindness which has autosomal recessive inheritance. It is characterized by typical clinical features in which there is golden yellow tapetal reflex over the fundus which disappears after prolonged dark adaptation. This clinical characteristic is known as "Mizuo-Nakamura phenomenon". Patients with Oguchi disease present with night blindness which is non-progressive and not associated with decreased vision, colour desaturation or visual field defects. We examined two patients who presented with night blindness since childhood. A 4 year boy and a 6 year old girl when examined in detail revealed Mizuo Nakamura phenomenon on fundus examination. They were further investigated with electrophysiological tests, optical coherence tomography and genetic studies to make a diagnosis of Oguchi's disease
RESUMEN
Objective: To determine mean change in visual acuity, corneal astigmatism and clinical appearance of pterygium after intralesional injection of 5-Fluorouracil
Methods: This was a Quasi experimental study conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from June 2014 to May 2015. Total 68 eyes of 54 patients were included in the study. Patients were treated by injecting 0.1 ml of 5-FU [5mg] weekly injections for 04 weeks. All the patients underwent ophthalmic clinical examination that included Uncorrected distant visual acuity [UCVA], corrected distant visual acuity [CDVA], keratometery with Auto Ref-keratometer [RK-F1, Canon] and slit lamp examination before and 04 weeks after the last injection
Results: Total 68 eyes of 54 patients [18 females and 36 males] were treated with intralesional injection of 5 FU. Out of total, 30 were right eyes while 38 were left eyes. Age of patients ranged from 23 to 53 years with mean age of 39.2 +/- 4.90 years. Mean UCVA and corneal astigmatism before treatment were 0.162 +/- 0.167 and 2.12 +/- 1.53 respectively while the same parameters 04 weeks after last injection of 5 FU were 0.166 +/- 0.168 and 1.92 +/- 1.45 respectively. The magnitude of induced change in astigmatism was [0.235 +/- 1.35]. Ninety seven percent of the patients showed improvement in clinical appearance
Conclusion: Intralesional 5-FU injection results in significant clinical and cosmetic improvement of primary pterygium
RESUMEN
Objective: To evaluate the effect of pan-retinal photocoagulation with Pattern Scan Laser [pascal] on best corrected visual acuity and central macular thickness in patients having proliferative diabetic retinopathy [PDR]
Methods: This study was conducted at AFIO, Rawalpindi, Pakistan from Oct 2014 to Jul 2015. Sixty seven eyes of 46 patients having proliferative diabetic retinopathy were included in the study. All patients underwent ophthalmic clinical examination including uncorrected distant visual acuity [UCVA], best corrected visual acuity [BCVA], fundus examination with slit lamp and optical coherence tomography to document the pretreatment central macular thickness [CMT]. Two sessions of PRP using Pattern Scan Laser were performed 04 weeks apart and OCT was repeated 04 weeks after the 2[nd] session. Central macular thickness and BCVA were documented
Results: Sixty seven eyes of 46 patients [29 females and 17 males] with mean age of 57.45 +/- 5.78 years underwent treatment with two sessions of laser PRP. Mean pretreatment BCVA was 0.67 +/- 0.43 and mean post-treatment BCVA was 0.57 +/- 0.3. Mean central macular thickness [CMT] as measured by OCT was 391.93 +/- 170.43 before treatment and 316.91 +/- 90.42 um after treatment. The magnitude of induced change in CMT after treatment was 75.01 +/- 90.75 and BCVA was 0.09 +/- 0.14
Conclusion: Laser PRP with Pattern scan laser alone in patients with combined presentation of PDR and DME is safe and effective
RESUMEN
Retinal artery occlusion is an uncommon condition but can lead to grave consequences if not managed in time
Elderly population with other comorbid conditions like hypertension, ischemic heart disease, hyperlipidemia and stroke are commonly affected. However, this condition may affect younger population with entirely different systemic associations
Thromboembolism, which usually takes place secondary to cardiac emboli or hypercoagulable states cause retinal artery occlusion in young population
A 24-year lady presented with a short history of unilateral altitudinal visual loss
On examination, she was found to have hemiretinal artery occlusion. Ocular massage, anterior chamber paracentesis was performed initially, followed by Nd YAG laser embolysis, which led to successful restoration of retinal circulation and significant improvement in visual field loss
Detailed evaluation and systemic investigations were carried out to identify the underlying cause, but no systemic association could be found
RESUMEN
Objective: To determine mean change in visual acuity, central corneal thickness and symptoms in patients with pseudophakic bullous keratopathy after treatment with corneal collagen crosslinking
Methods: This quasi experimental study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from April 2015 to Nov 2015. A total of 24 eyes of 24 patients were included in the study. Visual symptoms were graded in five grades [Grade 1-5], Grade-1 being very mild with decreased vision only while patients with all five symptoms [decreased vision, foreign body sensations, pain, watering and photophobia] were graded as Grade-5. Corneal collagen cross linking using topical isotonic riboflavin followed by UVA radiations [3mW/cm[2] for 10 minutes] was performed in all the patients
Visual acuity [VA], visual symptoms and central corneal thickness [CCT] were recorded before and 04 weeks after the treatment
Results: A total of 24 eyes of 24 patients [18 male and 6 females] underwent surgery
Age of the patients ranged from 55 to 75 years with mean age 65.83 + 3.89 years. Mean visual acuity was 2.09 + 0.23 before treatment while after treatment it was 2.13 + 0.22. Mean CCT as measured by optical pachymetry [Galilae G6] was 753.96 + 55.16 and 641+ 29.25 before and after surgery respectively. Improvement of clinical symptoms was seen in all the patients
Conclusion: Corneal collagen cross linking is a temporary but effective symptomatic treatment of pseudophakic bullous keratopathy
RESUMEN
Objective: To compare the mean optic nerve sheath diameter [ONSD] in patients with idiopathic intracranial hypertension [IIH] versus normal healthy individuals using B-scan ultrasonography as diagnostic tool
Study Design: Cross-sectional analytical study
Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi, Pakistan, from June to December 2015
Methodology: Participants aged 30 - 50 years were divided into two groups. Group A [GP] comprised of patients who were diagnosed cases of idiopathic intracranial hypertension while normal healthy adults who volunteered to participate in the study were included in Group B [GC]. Ocular B mode ultrasound scan was performed on all the participants and each eye was considered separately. The optic nerve head was visualized as a linear hypoechoic structure, and ONSD was measured 3 mm behind the retina. A total of three readings were taken by the same radiologist and the average of three was recorded. Mean values of both groups were compared by t-test with significance at p < 0.05
Results: Fifty-two eyes of 26 patients [26 eyes in each group] were included in the study. Twenty-four out of 26 in Group A [GP] and 23 out of 26 in Group B [GC] were females. Mean age of the patients was 33.92 +/-4.89 years in group A [GP] while it was 34.69 +/-4.79 years in group B [GC]. Mean ONSD was 6.61 +/-0.39 mm in group A [GP] and 4.33 +/-0.38 mm in group B[GC] which was significantly different [p < 0.001]
Conclusion: Ultrasound can provide a reliable, non-invasive tool to measure optic nerve sheath diameter in monitoring the patients with benign intracranial hypertension [BIH]
RESUMEN
To compare the mean root mean square [RMS] of total higher order aberrations [HOAs], coma and spherical aberrations in individuals with myopia, hypermetropia and myopic astigmatism. This prospective analytical study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from Jan 2014 to Dec 2014. Two hundred eyes of 121 patients with age ranging from 18-40 years were included in the study. Patients were divided into 4 group namely Low myopia, High myopia, Astigmatism and Hypermetropia on the basis of refractive error. Included were the patients who had refractive error more than +/- 0.5D and best corrected visual acuity [BCVA] of 0.00 or better. Patients who had history of surgery and / or eye disease were excluded from the study. Visual acuity [VA], Spherical equivalent [SE] of refractive error, RMS value of total HOAs, coma and spherical aberrations were evaluated. HOAs were measured with aberrometer [Wavelight analyzer version 1073] at 6 mm pupil size. Age of the patients ranged from 18 years to 40 years with mean age of 29.10 +/- 10.6 years. Seventy one [35.5%] were males and 129 [64.5%] were female. Mean RMS value of HOAs, coma and spherical aberrations was calculated in all four groups. RMS of total HOAs and spherical aberrations in hypermetropia was 0.96 +/- 0.96 and 0.30 +/- 0.42 respectively and it was higher than other three groups. In overall comparison the mean RMS of total HOAs and spherical aberrations was significantly increased in hypermetropia group and there was a statistically significant negative correlation of SE of hypermetropia with RMS of total HOAs and spherical aberration
RESUMEN
To determine mean change induced in root mean square value of higher order aberrations in myopic patients undergoing wavefront optimized laser assisted in situ keratomileusis. This quasi experimental study was conducted at Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from Jan 2014 to Dec 2014. Sixty eyes of 35 myopic patients were included in the study. All patients underwent wavefront optimized [WFO] laser assisted in situ keratomileusis [LASIK] using femtosecond laser [FM 200Wavelight technologies] and excimer laser [Ew SOOWavelight technologies]. Higher order aberrations [HOAs] were measured with aberrometer [Wavelight allegro analyzer version 1073] during preoperative assessment and one month after surgery. All 35 patients ranged from 20 to 32 years with a mean age of 24 +/- 3.41 years. Refractive error ranged from -1.00 to -9.50 DS with a mean spherical equivalent [SE] of -3.73 +/- 1.95 before surgery and - 0.36 +/- 1.50DS one month after LASIK. Uncorrected visual acuity [UCVA] was improved to 0.00 or better in all 60 eyes. An increase of 1.56 fold was observed in RMS of total HOAs. Among the HOAs, a statistically significant positive correlation was observed between spherical aberrations [4[th] order aberration] and preoperative spherical equivalent. In spite of excellent improvement in refractive error, significant amount of higher order aberrations were induced after WFO LASIK